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Minority Race is an Independent Risk Factor for Hospitalization for Aortic Dissection - A Statewide Population Based Analysis
Donald G. Harris, MD, Charles B. Drucker, MD, Elena Klyushnenkova, MD, Abhi Bhardwaj, MD, Joseph Rabin, MD, Wallace R. Johnson, MD, Shahab Toursavadkohi, MD, Marshall E. Benjamin, MD, Jose J. Diaz, MD, Robert S. Crawford, MD.
University of Maryland, Baltimore, MD, USA.

OBJECTIVES: Aortic dissection (AD) is the most common aortic emergency. Minorities are disproportionately affected by major cardiovascular disease, but the contribution of race to AD is poorly studied. To better define racial differences in AD, we performed a statewide population analysis of the effect of race on hospitalization and outcomes for AD.

METHODS:
This was a retrospective study of AD in Maryland during 2009-2014 using the Health Services Cost Review Commission dataset, a comprehensive statewide inpatient registry. Patients with AD were identified by ICD9 codes, and stratified by race (white vs. non-white). Admission rates were adjusted to statewide and county-level population data. Tertiary hospital admission and aortic intervention (fenestration, or open or endovascular repair) were used as markers of access to specialized vascular care. Demographics, comorbidities, access, and mortality were compared between groups, with multivariate analysis of risk factors for AD.

RESULTS: Of 3,719,412 admissions to Maryland hospitals during the study period, 3,190 had AD (0.09%; 1665 white, 1525 non-white). Non-white race was more common in patients with AD than without (48% vs. 41%, P<0.0001). Adjusted for statewide demographics, admission for AD was 1.4 times more common among non-whites (11 vs. 8 per 100,000, P<0.0001). However, there was significant variation between counties in AD rates (non-white:white ratio range 0.25-5.12×). Adjusting for demographics and comorbidities, non-white race was an independent risk factor for AD (OR 1.5, 95% CI 1.4 - 1.7). Among patients with AD, non-whites were younger and more often female, but had similar or lower rates of cardiovascular comorbidities (Table 1). Non-white patients were more likely to be admitted to a tertiary hospital (OR 1.2, 1.1 - 1.4), but non-white race was not associated with differences in aortic intervention (OR 0.9, 0.8 - 1.1) or mortality (OR 0.8, 0.6 - 1.1).

CONCLUSIONS:Hospitalization for AD is more frequent among non-whites, who develop AD at younger ages despite fewer comorbidities. While epidemiologic conclusions are limited from this dataset, this may reflect more severe pathophysiology from clinical or socioeconomic factors in minorities. Further study is warranted to better define this disparity, and identify high-risk subgroups who may benefit from aggressive primary prevention.
Table 1: Comparison of White and Non-White Patients with Aortic Dissection
White,n=1665Non-White, n=1525P
Age, years ± SD70 ± 1561 ± 16< 0.0001
Male, n (%)1038 (62%)853 (56%)< 0.001
Hypertension, n (%)797 (48%)695 (46%)0.19
Coronary artery disease, n (%)656 (39%)390 (26%)< 0.0001
COPD, n (%)371 (22%)197 (13%)< 0.0001
Tertiary hospital, n (%)609 (37%)633 (42%)< 0.01
Aortic intervention, n (%)368 (22%)321 (21%)0.47
Mortality, n (%)135 (8%)106 (7%)0.22


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